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General NPI Number Information
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NPI Number | 1720079528
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Entity Type | Individual
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Provider Name | CHRISTOPHER FUNK DPM
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Gender | Male
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Dates
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Enumeration Date | 10/31/2005
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Last Update Date | 07/23/2024
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Provider Practice Location Address
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Address Line | 3130 S HIGHLAND DR STE B4
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City | SALT LAKE CITY
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State | UT
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Zip | 84106-3095
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Country | US
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Telephone | 801-253-6886
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Fax | 385-900-5928
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Provider Business Mailing Address
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Address Line | 280 S MAIN ST
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City | BOUNTIFUL
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State | UT
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Zip | 84010-6236
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Country | US
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Telephone | 801-505-0821
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Fax | 801-505-0803
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 0542
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License Number State | AZ
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | P-289
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License Number State | ID
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | 374325-0501
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License Number State | UT
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